Osteoarticular Sporotrichosis Research Articles

169 Diagnosis of osteoarticular sporotrichosis in a immunocompetent female

This is a report of a sporotrichosis case in a immunocompetent host: DJF, a 50 years old female veterinarian, admitted in an ambulatory of infecto-parasitic dermatoses in 2022. Her chief complaint was a hand wound with 1 month of evolution. Patient reported that she had been bitten by a cat 1 month prior, followed by local swelling, pain and erythema. She had already been medicated with antibiotics. After these treatments there was only partial improvement - in dermatologic examination the physician could still see nodular lesions on the back and palm of the right hand, at the site of the cat’s bite, with erythema, swelling and local pain, measuring 1cm.

Sporotrichosis: A brief review

Sporotrichosis is a chronic mycotic infection caused by dimorphic fungus Sporothrix schenckii, a common saprophyte of soil and plant detritus. According to recent phylogenetic studies, it is a complex of at least six cryptic species with distinct biochemical properties, geographical distribution, virulence, disease patterns, and therapeutic response. S. globosa is the commonest isolated strain in India and evidently responsible for most cases of treatment failure. The disease is endemic in tropical/subtropical regions with occasional large breakouts. In India most cases have been reported along the sub-Himalayan regions. The characteristic cutaneous and subcutaneous infection follows traumatic inoculation of the pathogen. Zoonotic transmission attributed to insect/bird bites, fish handling, and bites of animals is perhaps because of wound contamination from infected dressings or indigenous/herbal poultices and so is human-to-human spread. Progressively enlarging papulo-nodule(s) at the inoculation site develop(s) after a variable incubation period which will evolve into fixed cutaneous sporotrichosis or lymphocutaneous sporotrichosis. Primary pulmonary sporotrichosis following inhalation of conidia and osteoarticular sporotrichosis due to direct inoculation are rare forms. Persons with immunosuppression (HIV, immunosuppressive and anticancer therapy) may develop disseminated cutaneous sporotrichosis or systemic sporotrichosis particularly involving central nervous system. Clinical suspicion is the key for early diagnosis and histologic features remain variable. The demonstration of causative fungus in laboratory culture is confirmatory. Oral itraconazole is the currently recommended treatment for all forms of sporotrichosis but saturated solution of potassium iodide is still used as first-line treatment for uncomplicated cutaneous sporotrichosis in resource poor settings. Terbinafine has been found effective in the treatment of cutaneous sporotrichosis in few studies. Amphotericin B is used initially for the treatment of severe or systemic disease, during pregnancy and in immunosuppressed patients until recovery, and follow-on therapy is with itraconazole until complete (mycological) cure. Posaconazole and ravuconazole remain understudied while echinocandins and voriconazole are not effective.

Disseminated Cutaneous and Osteoarticular Sporotrichosis Mimicking Pyoderma Gangrenosum

Disseminated sporotrichosis may present with inflammatory arthritis and cutaneous ulcerations that mimic noninfectious skin conditions such as pyoderma gangreonsum (PG). Sporotrichosis must therefore be ruled out before administering immunosuppressive agents for PG. Furthermore, dimorphic fungi such as sporotrichosis may grow as yeast in bacterial cultures, even before fungal cultures become positive. We present a case of disseminated cutaneous and osteoarticular sporotrichosis mimicking PG and describe the differential diagnosis and the diagnostic and treatment approach to this condition.

Sporotrichosis as an unusual case of osteomyelitis: A case report and review of the literature

Sporotrichosis is an infection of worldwide distribution caused by the dimorphic fungus, Sporothrix schenckii. Acquisition typically occurs via cutaneous inoculation with development of a localized cutaneous and/or lymphocutaneous infection. We present a rare case of osteoarticular sporotrichosis in a 39-year-old man and review the literature noting only 20 published cases since 1980. Recommendations on the diagnosis and management of this unusual infection are provided.

Sporotrichosis: an overview and therapeutic options.

Sporotrichosis is a chronic granulomatous mycotic infection caused by Sporothrix schenckii, a common saprophyte of soil, decaying wood, hay, and sphagnum moss, that is endemic in tropical/subtropical areas. The recent phylogenetic studies have delineated the geographic distribution of multiple distinct Sporothrix species causing sporotrichosis. It characteristically involves the skin and subcutaneous tissue following traumatic inoculation of the pathogen. After a variable incubation period, progressively enlarging papulo-nodule at the inoculation site develops that may ulcerate (fixed cutaneous sporotrichosis) or multiple nodules appear proximally along lymphatics (lymphocutaneous sporotrichosis). Osteoarticular sporotrichosis or primary pulmonary sporotrichosis are rare and occur from direct inoculation or inhalation of conidia, respectively. Disseminated cutaneous sporotrichosis or involvement of multiple visceral organs, particularly the central nervous system, occurs most commonly in persons with immunosuppression. Saturated solution of potassium iodide remains a first line treatment choice for uncomplicated cutaneous sporotrichosis in resource poor countries but itraconazole is currently used/recommended for the treatment of all forms of sporotrichosis. Terbinafine has been observed to be effective in the treatment of cutaneous sporotrichosis. Amphotericin B is used initially for the treatment of severe, systemic disease, during pregnancy and in immunosuppressed patients until recovery, then followed by itraconazole for the rest of the therapy.

Successful treatment of a disseminated Sporothrix schenckii infection and in vitro analysis for antifungal susceptibility testing

We report a case of a diabetic patient with localized osteoarticular sporotrichosis followed by widespread dissemination of the infection, which was successfully treated with amphotericin B. In addition, we evaluated the in vitro antifungal activity of 4 agents against both the mycelial and the yeast forms of the isolated fungus.

Sporothrix schenckii and sporotrichosis

For a long time sporotrichosis has been regarded to have a low incidence in Brazil; however, recent studies demonstrate that not only the number of reported cases but also the incidence of more severe or atypical clinical forms of the disease are increasing. Recent data indicate that these more severe forms occur in about 10% of patients with confirmed diagnosis. The less frequent forms, mainly osteoarticular sporotrichosis, might be associated both with patient immunodepression and zoonotic transmission of the disease. The extracutaneous form and the atypical forms are a challenge to a newly developed serological test, introduced as an auxiliary tool for the diagnosis of unusual clinical forms of sporotrichosis.

Disseminated Osteoarticular Sporotrichosis

We report a case of multiple skin lesions, lymphadenopathy, and osteoarticular sporotrichosis in a man infected with human immunodeficiency virus (HIV). He subsequently died of tuberculosis after successful treatment for osteoarticular sporotrichosis with amphotericin B. We describe the unusual histopathology in disseminated sporotrichosis with acquired immunodeficiency syndrome (AIDS) and compare it with that seen in patients without AIDS. Although the optimal treatment of osteoarticular sporotrichosis in patients with AIDS is unknown, use of amphotericin B in our patient appeared successful. Culture and histologic stains of all tissues taken at autopsy were negative for sporotrichosis. Recent studies of similar cases have shown initial treatment with amphotericin B followed by long-term maintenance with itraconazole to be beneficial.

Old and New Therapies for Sporotrichosis

The old therapies for sporotrichosis--saturated solution of potassium iodide (SSKI) and amphotericin B--have largely been supplanted by itraconazole treatment. Although SSKI is effective for the treatment of lymphocutaneous sporotrichosis, it is difficult to administer and is frequently associated with side effects; response rates of >90% are associated with itraconazole therapy for lymphocutaneous sporotrichosis. Patients with osteoarticular sporotrichosis rarely have systemic symptoms and can be effectively treated with a prolonged course of itraconazole, thus obviating the need for intravenous amphotericin B therapy with its associated toxic effects. Pulmonary sporotrichosis in patients infected with human immunodeficiency virus continue to be difficult therapeutic problems, but itraconazole appears to be at least as effective as amphotericin B as treatment for these forms of sporotrichosis.